Clubfoot deformity in Children

Musculoskeletal System, Neonatology No Responses »
Aug 102011
The most common congenital disorder of the lower extremities, clubfoot, or talipes, is marked primarily by a deformed talus and shortened Achilles tendon, which give the foot a characteristic clublike appearance. In talipes equinovarus, the foot points downward (equinus) and turns inward (varus), and the front of the foot curls toward the heel (forefoot adduction).
Clubfoot, which has an incidence of about 1 per 1,000 live births, usually occurs bilaterally and is twice as common in boys as it is in girls. It may be associated with other birth defects, such as myelomeningocele, spina bifida, and arthrogryposis. Clubfoot is correctable with prompt treatment.
Causes
A combination of genetic and environmental factors in utero appears to cause clubfoot. Heredity is a definite factor in some cases, although the mechanism of transmission is undetermined. If a child is born with clubfoot, his sibling has a 1 in 35 chance of being born with the same anomaly. Children of a parent with clubfoot have 1 chance in 10.
In children without a family history of clubfoot, this anomaly seems linked to arrested development during the 9th and 10th weeks of embryonic life, when the feet are formed. Researchers also suspect muscle abnormalities, leading to variations in length and tendon insertions, as possible causes of clubfoot.
Signs and symptoms
Talipes equinovarus varies in severity. Deformity may be so extreme that the toes touch the inside of the ankle, or it may be only vaguely apparent.
In every case, the talus is deformed, the Achilles tendon shortened, and the calcaneus somewhat shortened and flattened. Depending on the degree of the varus deformity, the calf muscles are shortened and underdeveloped, with soft-tissue contractures at the site of the deformity. The foot is tight in its deformed position and resists manual efforts to push it back into normal position.
Clubfoot is painless, except in older, arthritic patients. In older children, clubfoot may be secondary to paralysis, poliomyelitis, or cerebral palsy, in which case treatment must include Continue reading »
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Growing Pains in Children

Musculoskeletal System 1 Response »
Feb 062011
Growing pains are the most common cause of recurrent limb pain in childhood. A debate concerning the entity of growing pains has been ongoing for decades.
Causes
Growing pain is probably a misnomer because the pains are not associated with physiological growth. There appears to be no correlation between the occurrence of growing pains and the rapid phase of growth, epiphyseal closure, or hormonal changes. Perhaps this term is used because the condition occurs in growing people and does not usually occur in adulthood (after cessation of growth). An extension of the syndrome in adults may include restless leg syndrome.
Incidence
It appears that the prevalence of growing pains is between 4.2 and 33.6%; however, this wide range is dependent on the criteria utilized for diagnosis. The low incidence reported by Naish and Apley was indicative of their stricter criteria: recurrent pain lasting at least 3 months and causing disruption of normal daily activities.

Pathogenesis
The pathogenesis of growing pain is unknown. Many etiologies have been suggested, including orthopedic deformities, postural abnormalities, and psychosocial problems. Studies have shown that there is a familial incidence of growing pains and emotional disturbances. Oster reported that 39.2% of the children had multiple symptoms, with headache or abdominal pain in addition to the limb pain. Apley suggested that recurrent limb pains were perhaps an expression of a reaction pattern that might partly reflect an emotional disturbance or might reflect part of a familial pattern of pain reactivity.
Clinical Characterisitics
Growing pains are characterized as deep aching located in nonarticular sites, primarily within the muscle groups. The pain is typically bilateral, usually occurring late in the day or the evening. The pain is not associated with limping or limited mobility. There is no history of trauma or infection, and objective findings are lacking on physical examination. The areas most frequently involved include the thighs, calves, popliteal fossae, and, occasionally, the forearms and trunk. Rarely the pain is located in the periarticular tissues. The complaint of intrinsic joint pain should not be misdiagnosed as growing pains, but rather should herald a thorough investigation for causes of articular pain, such as infection, neoplasm, connective tissue diseases, and orthopedic and endocrine disorders.
Growing pains may occur during the day or evening, and occasionally may awaken the child from sleep. In contrast to patients with JRA, these children are usually asymptomatic in the morning. Continue reading »
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Radiographic Findings in Slipped Capital Femoral Epiphysis

Musculoskeletal System No Responses »
Sep 032010

Plain Radiography

Plain radiography in anteroposterior and lateral views is the primary and often the only imaging study needed to evaluate a slipped epiphysis. Common radiographic findings include widening and irregularity of the physis, a decrease in epiphyseal height in the center of the acetabulum, a crescent-shaped area of increased density in the proximal portion of the femoral neck, and the “blanch sign of Steel” corresponding to the double density created from the anteriorly displaced femoral neck overlying the femoral head.

In an unaffected patient, the Klein line, a straight line drawn along the superior cortex of the femoral neck on anteroposterior radiograph, intersects the lateral capital epiphysis. As progressive displacement of the epiphysis occurs in SCFE, the amount of the Klein line that intersects the epiphysis decreases, compared with the uninvolved hip, and eventually the line fully misses intersection with the proximal femoral epiphysis . A true lateral (cross-table lateral) radiographic view of the hip better defines the extent of posterior displacement of the femoral epiphysis.

Computed Tomography.

CT can be used to confirm epiphyseal displacement and accurately measure the amount of Continue reading »

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